Digestive system in children. Gastritis, cholecystitis, dyskinesia of biliary ducts

Age anatomo-physiological peculiarities ofAge anatomo-physiological peculiarities of
digestive system in children. Semiotics ofdigestive system in children. Semiotics of
disturbances of digestive organs and thedisturbances of digestive organs and the
main diseases (gastritis, ulcerative disease,main diseases (gastritis, ulcerative disease,
cholecystitis, dyskinesia of biliary ducts, etc.)cholecystitis, dyskinesia of biliary ducts, etc.)
in children. Syndrome of “acute abdomen”.in children. Syndrome of “acute abdomen”.

Plan of the LecturePlan of the Lecture
1.Anatomo-physiological1.Anatomo-physiological
peculiarities of digestive organspeculiarities of digestive organs
in children.in children.
2.Methods of investigation of2.Methods of investigation of
digestive organs in children.digestive organs in children.
3. The main clinico-laboratory3. The main clinico-laboratory
syndromes under digestivesyndromes under digestive
organs diseases in children.organs diseases in children.
4. Clinics of diseases of gastro-4. Clinics of diseases of gastro-
duodenal area in children.duodenal area in children.
5. Care of children with digestive5. Care of children with digestive
tract disturbances.tract disturbances.

Peculiarities of the structure of oral cavityPeculiarities of the structure of oral cavity
Oral cavity in a child of the 1st year of life is relativelyOral cavity in a child of the 1st year of life is relatively
small, the tongue is rather large, the chin is flattened, fattysmall, the tongue is rather large, the chin is flattened, fatty
bodies of the cheeks are well developed, the gums arebodies of the cheeks are well developed, the gums are
thickened, transverse folds on mucous membranes of thethickened, transverse folds on mucous membranes of the
lips are well expressed. Peculiarities of masticatorylips are well expressed. Peculiarities of masticatory
apparatus in newborns are connected with the act ofapparatus in newborns are connected with the act of
mastication.mastication.

Peculiarities of the structure of oralPeculiarities of the structure of oral
cavitycavity
Mucous membrane of oral cavity is dryish, rich of bloodMucous membrane of oral cavity is dryish, rich of blood
vessels, very gentle. Secretion of mucus is achieved byvessels, very gentle. Secretion of mucus is achieved by
sublingual, parotid, maxillary and very many smallsublingual, parotid, maxillary and very many small
glands. In the first 3 months secretion of saliva is little,glands. In the first 3 months secretion of saliva is little,
but under its influence in oral cavity starts digestion ofbut under its influence in oral cavity starts digestion of
carbohydrates and clotting of milk casein.carbohydrates and clotting of milk casein.
At the age of 3-6 months increased secretion of saliva isAt the age of 3-6 months increased secretion of saliva is
observed, caused by the exertion of tricuspid nerve byobserved, caused by the exertion of tricuspid nerve by
the teeth which start to erupt and also by introduction ofthe teeth which start to erupt and also by introduction of
extra feed. Also is observed physiological hypersalivationextra feed. Also is observed physiological hypersalivation
connected with inability of a child to swallow saliva.connected with inability of a child to swallow saliva.

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The teethThe teeth
in childrenin children
• In the first months after birth the teeth are situated under theIn the first months after birth the teeth are situated under the
mucous membrane of gums. Eruption of teeth starts at 6mucous membrane of gums. Eruption of teeth starts at 6
months age. This process may go on with deviationsmonths age. This process may go on with deviations
depending on the condition of a child. The child becomesdepending on the condition of a child. The child becomes
very excitable, sleep is disturbed, hypersalivation takesvery excitable, sleep is disturbed, hypersalivation takes
place, the body temperature rises.. After eruption of theplace, the body temperature rises.. After eruption of the
teeth all negative phenomena disappear, the child calmsteeth all negative phenomena disappear, the child calms
down.down.
• On each half of the jaw simultaneously erupt the teeth ofOn each half of the jaw simultaneously erupt the teeth of
the left and right sides of the oral cavity. More frequently atthe left and right sides of the oral cavity. More frequently at
first erupt the lower teeth, then the upper ones.first erupt the lower teeth, then the upper ones.

The teeth inThe teeth in
childrenchildren
• Milk teeth in the number of 20 appear in the periodMilk teeth in the number of 20 appear in the period
from 6 to 24 months (their number is counted withfrom 6 to 24 months (their number is counted with
a formula “age of a child -4”). Central incisorsa formula “age of a child -4”). Central incisors
appear in the 6appear in the 6thth
, 8, 8thth
month (at first the lower, thenmonth (at first the lower, then
the upper ones). Lateral incisors erupt in the 8-12the upper ones). Lateral incisors erupt in the 8-12thth
months, premolars – in the 16-20months, premolars – in the 16-20thth
months, molars –months, molars –
in the 20-30 months. Milk teeth are lost beginningin the 20-30 months. Milk teeth are lost beginning
with 6-7 years. Permanent teeth in the number ofwith 6-7 years. Permanent teeth in the number of
32 start to erupt from 6-7 years. The process is32 start to erupt from 6-7 years. The process is
finished up to 17-20 years or later.finished up to 17-20 years or later.

Peculiarities of the structure ofPeculiarities of the structure of
esophagusesophagus
Mucous membrane is very gentle, there is insufficientMucous membrane is very gentle, there is insufficient
development of elastic muscular fibers, there is almostdevelopment of elastic muscular fibers, there is almost
full absence of glands.full absence of glands.
The upper border of esophagus is situated higher thanThe upper border of esophagus is situated higher than
in adults (in newborns- on the level of 3-4 cervicalin adults (in newborns- on the level of 3-4 cervical
vertebra, in adults – on the level of 6 cervical vertebra).vertebra, in adults – on the level of 6 cervical vertebra).
In children there are highly expressed physiologicalIn children there are highly expressed physiological
narrowings: the 1narrowings: the 1stst
– on the site of tansition of the throat– on the site of tansition of the throat
into esophagus, the 2into esophagus, the 2ndnd
–on the site of attaching of–on the site of attaching of
esophagus to the aorta, the 3esophagus to the aorta, the 3rdrd
- on crossing of the- on crossing of the
esophagus through diaphragmal opening.esophagus through diaphragmal opening.

The main functionsThe main functions
of the stomachof the stomach
• Secretory - saline acid, pepsin, mucin, mycoproteids areSecretory - saline acid, pepsin, mucin, mycoproteids are
produced;produced;
• Mechanical – deposition of food, mixing it with gastricMechanical – deposition of food, mixing it with gastric
juice;juice;
• Incretory – secretion of gastrin and pepsinogen in theIncretory – secretion of gastrin and pepsinogen in the
blood;blood;
• Resorptive – assimilation of proteins, water, electrolites;Resorptive – assimilation of proteins, water, electrolites;
• Protective –bactericidal action of gastric juice preventsProtective –bactericidal action of gastric juice prevents
the development of bacteria, vomiting reflex leads tothe development of bacteria, vomiting reflex leads to
removal of bad quality food.removal of bad quality food.

Peculiarities of the structurePeculiarities of the structure
of the stomachof the stomach
In newborn children the cardial portion, the bottom ofIn newborn children the cardial portion, the bottom of
the stomach, the Gyss angle are poorlythe stomach, the Gyss angle are poorly
developed. The Gubarev’s valve is not welldeveloped. The Gubarev’s valve is not well
expressed, muscular fibers of the inner obliqueexpressed, muscular fibers of the inner oblique
layer of the stomach are weak, and this promoteslayer of the stomach are weak, and this promotes
throwing its contents into the esophagus, causesthrowing its contents into the esophagus, causes
regurgitation, vomiting, development of pepticregurgitation, vomiting, development of peptic
disturbances of mucous membrane of esophagusdisturbances of mucous membrane of esophagus
in children of the 1in children of the 1stst
year of life. In babies of the 1year of life. In babies of the 1stst
year of life the stomach has a shape of ‘turnedyear of life the stomach has a shape of ‘turned
upside bottle’ (poorly developed cardial portionupside bottle’ (poorly developed cardial portion
and well developed pyloric part).and well developed pyloric part).

Functional peculiarities ofFunctional peculiarities of
the stomachthe stomach
• In newborns and babies of the breast feedingIn newborns and babies of the breast feeding
age the majority of gastric functions areage the majority of gastric functions are
decreased. But resorptive function in them isdecreased. But resorptive function in them is
increased, enzyme activity is decreased, pH isincreased, enzyme activity is decreased, pH is
high. Up to 2 months the source of carbon ionshigh. Up to 2 months the source of carbon ions
is milk acid. The duration of staying food in theis milk acid. The duration of staying food in the
stomach depends on the type of feeding: instomach depends on the type of feeding: in
natural feeding – 2-2.5h, in artificial – 3,5-4h.natural feeding – 2-2.5h, in artificial – 3,5-4h.
Evacuation of food from the stomach in childrenEvacuation of food from the stomach in children
of breast feeding age is hindered by proteins (inof breast feeding age is hindered by proteins (in
the adults – by fats).the adults – by fats).

Peculiarities of thePeculiarities of the
structure of the intestinestructure of the intestine
Duodenum has ring like shape, the border ofDuodenum has ring like shape, the border of
division of mesenteric portion of small intestinedivision of mesenteric portion of small intestine
into the jejunum and blind gut is not wellinto the jejunum and blind gut is not well
manifested. Bauhin’s valve is underdeveloped,manifested. Bauhin’s valve is underdeveloped,
causing invaginations, it also promotes throwingcausing invaginations, it also promotes throwing
the microbial contents of blind gut into jejunumthe microbial contents of blind gut into jejunum
with the development of inflammatory processeswith the development of inflammatory processes
in its terminal portion. Mucous membrane of thein its terminal portion. Mucous membrane of the
small intestine has very many villi, whichsmall intestine has very many villi, which
considerably increase its surface. Mesentery inconsiderably increase its surface. Mesentery in
children is rather long, promoting developmentchildren is rather long, promoting development
of invaginations, volvuli, hernias.of invaginations, volvuli, hernias.

structure of the intestinestructure of the intestine
• In large intestine the descending portion is longerIn large intestine the descending portion is longer
than the ascending portion. Mesentery of sigmoidthan the ascending portion. Mesentery of sigmoid
colon is relatively long. This may be the reason ofcolon is relatively long. This may be the reason of
frequent constipations in children. The blind gut isfrequent constipations in children. The blind gut is
situated lower than in adults. In the mucoussituated lower than in adults. In the mucous
membrane there are no circulary folds. Appendixmembrane there are no circulary folds. Appendix
often is situated atypically (retrocecally,often is situated atypically (retrocecally,
retrorenally, retroperitoneally, subhepatically), itretrorenally, retroperitoneally, subhepatically), it
has the shape of funnel and wide opening.has the shape of funnel and wide opening.
Rectum has underdeveloped muscular layer andRectum has underdeveloped muscular layer and
weak fixation of submucous layer, ptoducingweak fixation of submucous layer, ptoducing
conditions for its falling out.conditions for its falling out.

Functional peculiarities ofFunctional peculiarities of
the intestinethe intestine
• The duration of movement of food along the GITThe duration of movement of food along the GIT
comprises on an average 15h.: along smallcomprises on an average 15h.: along small
intestine 7-8h., along the large intestine - 4-12h.intestine 7-8h., along the large intestine - 4-12h.
• In newborns the rate of defecations comprises 5-In newborns the rate of defecations comprises 5-
7 times a day, up to 6 months – 2-3 times, in a7 times a day, up to 6 months – 2-3 times, in a
year – 1-2 times; in older children – from 1 timeyear – 1-2 times; in older children – from 1 time
in 2 days to 2 times in 1 day. In the first 2 daysin 2 days to 2 times in 1 day. In the first 2 days
in newborns is released meconium – thick,in newborns is released meconium – thick,
viscous mass of dark olive color without smellviscous mass of dark olive color without smell
(contents of the intestine of fetus). After 3 days –(contents of the intestine of fetus). After 3 days –
transition stool, from the 5transition stool, from the 5thth
day – usualday – usual
defecations.defecations.

Functional peculiarities of theFunctional peculiarities of the
intestineintestine
• In feeding a baby with breast milk the stool is of goldenIn feeding a baby with breast milk the stool is of golden
yellow color with sour smell, its consistency is like thickyellow color with sour smell, its consistency is like thick
soured cream. While staying in an air the stool becomessoured cream. While staying in an air the stool becomes
green (oxidation of bilirubin). With full assimilation ofgreen (oxidation of bilirubin). With full assimilation of
mother’s milk the amount of stool becomes less. Inmother’s milk the amount of stool becomes less. In
artificial feeding: defecations increase (because of lessartificial feeding: defecations increase (because of less
degree of assimilation), often alkaline.degree of assimilation), often alkaline.
• For a baby of the 1For a baby of the 1stst
half year in normal microbiocenosishalf year in normal microbiocenosis
dominating are bifidobacteria and lactobacteria. In the 2dominating are bifidobacteria and lactobacteria. In the 2ndnd
half a year increases almost in half the presence ofhalf a year increases almost in half the presence of
intestinal bacili, which start to prevail after 1 year of life.intestinal bacili, which start to prevail after 1 year of life.
Microflora of large intestine synthesizes vitamins B1, K,Microflora of large intestine synthesizes vitamins B1, K,
stimulates immune mechanism, fulfills barrier function.stimulates immune mechanism, fulfills barrier function.

structure of the liverstructure of the liver
• The liver in children is of considerably larger sizes. Up toThe liver in children is of considerably larger sizes. Up to
5-7 years it always bulges out from under the right costal5-7 years it always bulges out from under the right costal
arc along the medial clavicular line:arc along the medial clavicular line:
• Up to 3 years –for 2-3 cm;Up to 3 years –for 2-3 cm;
• Up to 4-5 years – for 1,0-1,5 cm;Up to 4-5 years – for 1,0-1,5 cm;
• Up to 7 years – for 0,5-1,0 cm.Up to 7 years – for 0,5-1,0 cm.
• Up to 7 months the gall-bladder has spindle like shapeUp to 7 months the gall-bladder has spindle like shape
and from 6 months – pear like shape. Up to 5 years theand from 6 months – pear like shape. Up to 5 years the
gall-bladder is situated more laterally than in adults, andgall-bladder is situated more laterally than in adults, and
has a bend curve. The bile in children containshas a bend curve. The bile in children contains
considerably less bile acids and this can be the reasonconsiderably less bile acids and this can be the reason
of appearing steatorrhea (indigestion of fats in theof appearing steatorrhea (indigestion of fats in the
stool).stool).

The functions of the liver:The functions of the liver:
• General metabolic – exchange of fats,General metabolic – exchange of fats,
proteins, carbohydrates, biologically activeproteins, carbohydrates, biologically active
substances, vitamins;substances, vitamins;
• Secretory – bile production;Secretory – bile production;
• Barrier – protective;Barrier – protective;
• Excretory – removal of toxins.Excretory – removal of toxins.

Functional peculiarities of the liverFunctional peculiarities of the liver
• The liver of a newborn has relatively large size, itThe liver of a newborn has relatively large size, it
composes about 4-4,4% of the body mass, is wellcomposes about 4-4,4% of the body mass, is well
vasculized, has not sufficiently developed connectivevasculized, has not sufficiently developed connective
tissue and poorly distincted particles. The liver istissue and poorly distincted particles. The liver is
functionally immature. The function of glycogenfunctionally immature. The function of glycogen
formation is well manifested, but poorly expressed is theformation is well manifested, but poorly expressed is the
function of dysintoxication. The liver takes part in thefunction of dysintoxication. The liver takes part in the
processes of digestion, blood formation, blood circulationprocesses of digestion, blood formation, blood circulation
and metabolism. The bile in the first months of theand metabolism. The bile in the first months of the
baby’s life is formed in little amount, contains little bilebaby’s life is formed in little amount, contains little bile
acids, much water, mucin, pigments; in newborns alsoacids, much water, mucin, pigments; in newborns also
there is much urea. The bile also has more taurocholicthere is much urea. The bile also has more taurocholic
acid than glycocholic one, promoting its bactericidalacid than glycocholic one, promoting its bactericidal
properties, stimulating secretion of the pancreas andproperties, stimulating secretion of the pancreas and
increasing peristalsis of the large intestine.increasing peristalsis of the large intestine.

PancreasPancreas
• Pancreas is the main gland of the digestive tract.Pancreas is the main gland of the digestive tract.
Its secretion especially quickly increases after introduction ofIts secretion especially quickly increases after introduction of
extra feed and reaches the level of an adult person at theextra feed and reaches the level of an adult person at the
age of 5 years.age of 5 years.
• The main enzymes of pancreatic juice are: trypsin,The main enzymes of pancreatic juice are: trypsin,
chemotrypsin, diastase, amylase, lipase, phospholipase,chemotrypsin, diastase, amylase, lipase, phospholipase,
incretory insulin.incretory insulin.
• Pancreas is morphologically underdeveloped (considerablePancreas is morphologically underdeveloped (considerable
development of connective tissue, rich vasculation,development of connective tissue, rich vasculation,
uncompleted differentiation of parenchyma).uncompleted differentiation of parenchyma).
• Lymphatic vessels are tightly connected with neighbouringLymphatic vessels are tightly connected with neighbouring
organs, promoting generalization of inflammatory process.organs, promoting generalization of inflammatory process.

Methods of examination of gastro-Methods of examination of gastro-
intestinal tract:intestinal tract:
1. Clinical methods of examination;1. Clinical methods of examination;
1.1 Questioning:1.1 Questioning:
- complaints;- complaints;
- anamnesis of the disease;- anamnesis of the disease;
- anamnesis of live.- anamnesis of live.
1.2. Physical methods of examination:1.2. Physical methods of examination:
- inspecton;- inspecton;
- palpation;- palpation;
- percussion;- percussion;
- auscultation.- auscultation.

2. Instrumental methods of examination of2. Instrumental methods of examination of
gastro-intestinal tract:gastro-intestinal tract:
• - X-ray examination (X-ray of organs of abdominal- X-ray examination (X-ray of organs of abdominal
cavity, X-ray of the esophagus and the stomach,cavity, X-ray of the esophagus and the stomach,
irrigography, cholesystography);irrigography, cholesystography);
• - radiological examination;- radiological examination;
• - ultrasound examination of the organs of abdominal- ultrasound examination of the organs of abdominal
cavity;cavity;
• - endoscopic methods- endoscopic methods
(esophagogastroduodenoscopy, colonofibroscopy,(esophagogastroduodenoscopy, colonofibroscopy,
rectoromanoscopy, laparoscopy);rectoromanoscopy, laparoscopy);
• - thermographic methods of examination (distance- thermographic methods of examination (distance
thermography);thermography);
• - bioptic methods of examination.- bioptic methods of examination.

Diaphragmal herniaDiaphragmal hernia

Endoscopic picture during gastritis (left)Endoscopic picture during gastritis (left)
and ulcerative disease (right)and ulcerative disease (right)

Methods of examination of gastrointestinalMethods of examination of gastrointestinal
tracttract
3. Functional methods of examination:3. Functional methods of examination:
• - determination of secretory-acidic-enzymatic functions- determination of secretory-acidic-enzymatic functions
of the stomach and pancreas (fractional examination ofof the stomach and pancreas (fractional examination of
gastric contents, determination of proteolytic function ofgastric contents, determination of proteolytic function of
the stomach, mucus production);the stomach, mucus production);
• - duodenal intubation;- duodenal intubation;
• - pH-metry;- pH-metry;
4. Laboratory methods of examination:4. Laboratory methods of examination:
- bacteriological examination of the stool;- bacteriological examination of the stool;
- macroscopic examination of the stool;- macroscopic examination of the stool;
- microscopic examination of the stool.- microscopic examination of the stool.

The main complaints during disturbances ofThe main complaints during disturbances of
digestive organsdigestive organs
Appetite:Appetite:
- preserved;- preserved;
- decreased or absent (under disturbance of CNS,- decreased or absent (under disturbance of CNS,
intoxication, acute diseases, intestinal infections, inintoxication, acute diseases, intestinal infections, in
preschool children – because of forced feeding, duringpreschool children – because of forced feeding, during
eating much sweet food, under helminths invasion, ineating much sweet food, under helminths invasion, in
school children – because of emotion before school);school children – because of emotion before school);
- increased - (bulimia) – chronic pancreatitis, starting of- increased - (bulimia) – chronic pancreatitis, starting of
diabetes mellitus;diabetes mellitus;
- disgust of some food products;- disgust of some food products;
- general food allergy;- general food allergy;
- thirst for nonfood products (chalk, soil), anemia;- thirst for nonfood products (chalk, soil), anemia;
- fear of rising of pain.- fear of rising of pain.

The main complaints under disturbances ofThe main complaints under disturbances of
• Thirst – sense of desire to drink water;Thirst – sense of desire to drink water;
• Polydipsia – increased thirst (inborn or acquired diseasesPolydipsia – increased thirst (inborn or acquired diseases
of the salivary glands, diseases of pancreas);of the salivary glands, diseases of pancreas);
• Adipsia – absence of desire to drink water (enterocolitis,Adipsia – absence of desire to drink water (enterocolitis,
stomatitis);stomatitis);
• Disphagia – violation of swallowing (in babies duringDisphagia – violation of swallowing (in babies during
tooth eruption and some other conditions);tooth eruption and some other conditions);
• Heartburn – sense of burning under the sternum mayHeartburn – sense of burning under the sternum may
take place before or after taking food, more frequently intake place before or after taking food, more frequently in
recumbent position or during physical exertion as arecumbent position or during physical exertion as a
result of cardial sphincter’s failure. It is promoted byresult of cardial sphincter’s failure. It is promoted by
eating fatty food, sweets and others.eating fatty food, sweets and others.

The main complaints under the disturbancesThe main complaints under the disturbances
of digestive organsof digestive organs
• Regurgitation – may take place in healthy childrenRegurgitation – may take place in healthy children
during quick eating, after drinking rich of gas beverages.during quick eating, after drinking rich of gas beverages.
It can be sour (during increased acid formation function),It can be sour (during increased acid formation function),
putrefactive (under congestion of the stomachputrefactive (under congestion of the stomach
contents).contents).
• Nausea. Often nausea takes place before vomiting.Nausea. Often nausea takes place before vomiting.
• Vomiting – (labor trauma, pylorospasm, pylorostenosis,Vomiting – (labor trauma, pylorospasm, pylorostenosis,
inborn intestinal disorders, intestinal infections, toxicosis,inborn intestinal disorders, intestinal infections, toxicosis,
traumas of the skull, ulcerative disease, gastritis,traumas of the skull, ulcerative disease, gastritis,
peritonitis). It is necessary to clarify the time of rising, theperitonitis). It is necessary to clarify the time of rising, the
rate, connection with the food eaten, presence and typerate, connection with the food eaten, presence and type
of added extra food, color, smell, sense of relief afterof added extra food, color, smell, sense of relief after
vomiting.vomiting.

The main complaints under the disturbancesThe main complaints under the disturbances
of digestive organsof digestive organs
Disturbed stool:Disturbed stool:
- diarrhea – during functional disturbances of digestion;- diarrhea – during functional disturbances of digestion;
- salmonellosis – liquid, frequent, marsh ‘slime’;- salmonellosis – liquid, frequent, marsh ‘slime’;
- dysentery – liquid, frequent, with mucus in the blood;- dysentery – liquid, frequent, with mucus in the blood;
- food toxic infections – liquid, frequent, dirty green color,- food toxic infections – liquid, frequent, dirty green color,
with mucus;with mucus;
- syndrome of malabsorption (mucoviscidosis- grey,- syndrome of malabsorption (mucoviscidosis- grey,
tenasious, steatorrhea; celiac disease-putrefactive,tenasious, steatorrhea; celiac disease-putrefactive,
polyfecalia);polyfecalia);
- during starvation in children with hypotrophy of I-II- during starvation in children with hypotrophy of I-II
degree – ‘hungry’ stool – small portions with admixturesdegree – ‘hungry’ stool – small portions with admixtures
of mucus.of mucus.

The main complaints during disturbances ofThe main complaints during disturbances of
Pain – it is necessary to reveal localization, spreading,Pain – it is necessary to reveal localization, spreading,
character, intensity, connection with taking food.character, intensity, connection with taking food.
Localization:Localization:
- in the mouth – stomatitis;- in the mouth – stomatitis;
- during swallowing – angina, peritonsillary abscess;- during swallowing – angina, peritonsillary abscess;
- during chewing – parotitis;- during chewing – parotitis;
- retrosternal – in disturbed esophagus;- retrosternal – in disturbed esophagus;
- in epigastric area - in disturbed stomach;- in epigastric area - in disturbed stomach;
- in pyloroduodenal zone – in disturbed duodenum;- in pyloroduodenal zone – in disturbed duodenum;
- there is early and late pain. Early pain arises during eating- there is early and late pain. Early pain arises during eating
or in 30 min after eating (gastritis). Late pain arises in 1,5-2hor in 30 min after eating (gastritis). Late pain arises in 1,5-2h
after taking food (gastroduodenitis, ulcerative disease).after taking food (gastroduodenitis, ulcerative disease).
There are also night and ‘hungry’ pains. In ulcerative diseaseThere are also night and ‘hungry’ pains. In ulcerative disease
of duodenum the pain has characteristic rhythm: hunger-of duodenum the pain has characteristic rhythm: hunger-
pain-relief after taking food.pain-relief after taking food.

Pain in the abdomenPain in the abdomen
• In intestinal disturbances arises pain of different durationIn intestinal disturbances arises pain of different duration
and intensity without strict localization: in chronic enteritis,and intensity without strict localization: in chronic enteritis,
colitis, mucoviscidosis, it arises in 1-2h after taking food, itscolitis, mucoviscidosis, it arises in 1-2h after taking food, its
intensity increases in eating food products, which promoteintensity increases in eating food products, which promote
fermentation; after defecation the pain decreases, but infermentation; after defecation the pain decreases, but in
definite time it increases again.definite time it increases again.
• Pain in the right hypochondrium – dull pain (in diskinesia ofPain in the right hypochondrium – dull pain (in diskinesia of
bile ducts of hypotonic type in chronicbile ducts of hypotonic type in chronic
cholecystocholangitis); acute sudden burning pain (incholecystocholangitis); acute sudden burning pain (in
diskinesia of bile ducts of hyperkinetic type). Pain irradiatesdiskinesia of bile ducts of hyperkinetic type). Pain irradiates
to the right shoulder and to the right shoulder blade.to the right shoulder and to the right shoulder blade.
• Encircling pains (in pancreatitis), increase after taking ofEncircling pains (in pancreatitis), increase after taking of
extra large amount of food or over-indulgence in fatty, fried,extra large amount of food or over-indulgence in fatty, fried,
strong food.strong food.
• In the right lower abdomen – acute appendicitis,In the right lower abdomen – acute appendicitis,
helminthiasis, mesadenitis.helminthiasis, mesadenitis.

Attention !Attention !
In early age children pains in the abdomenIn early age children pains in the abdomen
can be connected with : meteorism;can be connected with : meteorism;
underfeeding or overfeeding; inadequateunderfeeding or overfeeding; inadequate
milk mixture, gastroenterocolitis;milk mixture, gastroenterocolitis;
invagination, appendicitis, peritonitis;invagination, appendicitis, peritonitis;
pathology of urinary pathways.pathology of urinary pathways.

Bleeding:Bleeding:
- from the esophagus – (varicose veins of- from the esophagus – (varicose veins of
the esophagus under cirrhosis of the liver) -the esophagus under cirrhosis of the liver) -
bloody discharges from oral cavity;bloody discharges from oral cavity;
• from the stomach – (ulcer of the stomach,from the stomach – (ulcer of the stomach,
erosive gastroduodenitis, polyps) – vomiting witherosive gastroduodenitis, polyps) – vomiting with
coffee thick, tarry stools –melena;coffee thick, tarry stools –melena;
• from the large intestine – blood is on the surfacefrom the large intestine – blood is on the surface
of excrements (disturbed rectum), the bloodof excrements (disturbed rectum), the blood
mixed with defecation mass (disturbed sigmoidmixed with defecation mass (disturbed sigmoid
gut or descending portion of the colon).gut or descending portion of the colon).

• Itching – cirrhosis of the liver, chronic or acute hepatitis,Itching – cirrhosis of the liver, chronic or acute hepatitis,
food allergy;food allergy;
• Jaundice – in pathology of hepatobiliary system (jaundiceJaundice – in pathology of hepatobiliary system (jaundice
of newborns, hepatitis, pressing of the general bile ductof newborns, hepatitis, pressing of the general bile duct
by the enlarged head of the pancreas);by the enlarged head of the pancreas);
• Enlargement of the abdomen – in ascites, inEnlargement of the abdomen – in ascites, in
hepatosplenomegaly;hepatosplenomegaly;
• General intoxication – increased fatigue, irritability,General intoxication – increased fatigue, irritability,
headaches;headaches;
• Loss of body weight – more frequently is accompaniedLoss of body weight – more frequently is accompanied
with diseases of the small intestine, infectious diseaseswith diseases of the small intestine, infectious diseases
with the loss of water.with the loss of water.

The main clinico-laboratory syndromesThe main clinico-laboratory syndromes
1.1. Abdominal syndrome, syndrome of acuteAbdominal syndrome, syndrome of acute
abdomen.abdomen.
Causes: appendicitis, biliary colics, cholesistitis,Causes: appendicitis, biliary colics, cholesistitis,
diverticulitis, ileum, ulcer disease, renal colic,diverticulitis, ileum, ulcer disease, renal colic,
pyelonephritis, pneumonia.pyelonephritis, pneumonia.
The leading symptom – pain, accompanied withThe leading symptom – pain, accompanied with
shock, vomiting, delay of defecation, gases, seldomshock, vomiting, delay of defecation, gases, seldom
-diarrhea. Characteristic is the position of the-diarrhea. Characteristic is the position of the
patient: he is poorly movable, the legs are attachedpatient: he is poorly movable, the legs are attached
to the abdomen. The picture of intoxication is wellto the abdomen. The picture of intoxication is well
expressed. Positive symptom is irritation ofexpressed. Positive symptom is irritation of
peritoneum.peritoneum.

2. Syndrome of jaundice.2. Syndrome of jaundice.
- Develops as a result of accumulation in the blood extra- Develops as a result of accumulation in the blood extra
amount of bilirubin. Is expressed as yellow color of theamount of bilirubin. Is expressed as yellow color of the
skin, mucous membranes, sclera. There are threeskin, mucous membranes, sclera. There are three
types of jaundice:types of jaundice:
- over hepatic (hemolytic)- (caused by production of- over hepatic (hemolytic)- (caused by production of
extra amount of bilirubin with increase of indirectextra amount of bilirubin with increase of indirect
bilirubin);bilirubin);
- hepatic (parenchymatose) jaundice caused by- hepatic (parenchymatose) jaundice caused by
violation of catching, connecting and discharge ofviolation of catching, connecting and discharge of
bilirubin (hepatitis, cirrhosis);bilirubin (hepatitis, cirrhosis);
- subhepatic (mechanical) jaundice – caused by- subhepatic (mechanical) jaundice – caused by
violation of outflow of bile caused by occlusion of bileviolation of outflow of bile caused by occlusion of bile
ducts with tumors, helminths, gallstones).ducts with tumors, helminths, gallstones).

3. Syndrome of portal hypertension – increasing blood3. Syndrome of portal hypertension – increasing blood
pressure in the system of portal vein.pressure in the system of portal vein.
• Clinically: development of collateral blood circulationClinically: development of collateral blood circulation
(jelly fish’s head, varicosis of veins of esophagus and(jelly fish’s head, varicosis of veins of esophagus and
hemorrhoidal veins develop), bleeding from varicosehemorrhoidal veins develop), bleeding from varicose
veins, ascites, splenomegaly, dyspeptic signs, gettingveins, ascites, splenomegaly, dyspeptic signs, getting
thin.thin.
4. Hepatolienal syndrome.4. Hepatolienal syndrome.
- Causes: acute and chronic disturbances of the liver,- Causes: acute and chronic disturbances of the liver,
congenital and acquired defects of the portal systemcongenital and acquired defects of the portal system
vessels, systemic diseases of the blood, chronicvessels, systemic diseases of the blood, chronic
infections, diseases of cardiovascular system.infections, diseases of cardiovascular system.

5. Syndrome of hepatic insufficiency (HI).5. Syndrome of hepatic insufficiency (HI).
- Complexes of metabolic disturbances with violation of- Complexes of metabolic disturbances with violation of
the brain. There are acute and chronic forms of hepaticthe brain. There are acute and chronic forms of hepatic
insufficiency.insufficiency.
- Acute form develops as a result of massive necrosis of- Acute form develops as a result of massive necrosis of
hepatic cells (viral hepatitis, medicines, toxichepatic cells (viral hepatitis, medicines, toxic
substances).substances).
- Chronic HI – syndrome, characteristic of hepatic- Chronic HI – syndrome, characteristic of hepatic
cirrhosis. In chronic HI develops hepatic encephalopathycirrhosis. In chronic HI develops hepatic encephalopathy
– metabolic disturbances of the brain, which cause– metabolic disturbances of the brain, which cause
neuropsychic syndrome, curable in the initial stage andneuropsychic syndrome, curable in the initial stage and
incurable in the final stage.incurable in the final stage.

The main clinico-laboratoryThe main clinico-laboratory
syndromessyndromes
6.Syndrome of intestinal insufficiency includes:6.Syndrome of intestinal insufficiency includes:
- Violations of the processes of hydrolysis of food- Violations of the processes of hydrolysis of food
substrates (maldigestion).substrates (maldigestion).
- Violation of absorption (malabsorption).- Violation of absorption (malabsorption).
- Combination of violations of hydrolysis and absorption- Combination of violations of hydrolysis and absorption
(syndrome of malassimilation).(syndrome of malassimilation).
The main clinical manifestations: dyspeptic disturbancesThe main clinical manifestations: dyspeptic disturbances
(regurgitation, vomiting, meteorism), diarrhea,(regurgitation, vomiting, meteorism), diarrhea,
pathological admixtures in the stool, hypotrophy,pathological admixtures in the stool, hypotrophy,
intoxication, the volume of the abdomen is enlarged.intoxication, the volume of the abdomen is enlarged.
- In clinical practice the leading is malabsorption- In clinical practice the leading is malabsorption
syndrome.syndrome.

syndromessyndromes
7.7. Syndrome of acute gastroenterocolitis.Syndrome of acute gastroenterocolitis.
- Reason – infection (coli-infecton, salmonellosis,- Reason – infection (coli-infecton, salmonellosis,
dysentery, food toxico-infection), less frequently –dysentery, food toxico-infection), less frequently –
alimentary disturbances.alimentary disturbances.
- Clinical manifestations: vomiting, diarrhea, toxico-- Clinical manifestations: vomiting, diarrhea, toxico-
excicosis, decrease of body mass, dryness of the skinexcicosis, decrease of body mass, dryness of the skin
and mucous membranes, retraction of the colon.and mucous membranes, retraction of the colon.
- Under gastric disturbance - vomiting, pains in epigastric- Under gastric disturbance - vomiting, pains in epigastric
area, under enteritis – toxicosis, dehydratation,area, under enteritis – toxicosis, dehydratation,
diarrhea, colitis, diarrhea without signs of toxicosis anddiarrhea, colitis, diarrhea without signs of toxicosis and
dehydraton, the stool is liquid with admixtures ofdehydraton, the stool is liquid with admixtures of
mucus and streaks of blood.mucus and streaks of blood.

syndromessyndromes
8. Astheno-vegetative syndrome.8. Astheno-vegetative syndrome.
- Sluggishness, fatigue, depressed mood, violation of- Sluggishness, fatigue, depressed mood, violation of
concentration of attention, sleep, headache, inadequateconcentration of attention, sleep, headache, inadequate
behaviour.behaviour.
9. Congenital failure of development (pylorostenosis) –9. Congenital failure of development (pylorostenosis) –
congenital thickening of muscular layer of pyloric portioncongenital thickening of muscular layer of pyloric portion
of the stomach.of the stomach.
- ‘fountain’ vomiting with large amount of vomit masses;- ‘fountain’ vomiting with large amount of vomit masses;
- dyspeptic ‘hungry’ stool;- dyspeptic ‘hungry’ stool;
- decrease of the number of urinations;- decrease of the number of urinations;
- syndromes of dehydration, ‘sandy clock’;- syndromes of dehydration, ‘sandy clock’;
- decrease of body mass (less than after birth).- decrease of body mass (less than after birth).

Thanks for your attention!Thanks for your attention!

Digestive system in children. Gastritis, cholecystitis, dyskinesia of biliary ducts

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